Provider First Line Business Practice Location Address:
B240 LIFE SCIENCE BLDG
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48824-1317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-353-2046
Provider Business Practice Location Address Fax Number:
517-353-8464
Provider Enumeration Date:
10/18/2005